Set and don’t forget

52-year-old female with COVID-19 pneumonia and ARDS was intubated and placed on a Servo-U ventilator using Volume Control mode aiming lung protective settings. However, three hours after intubation, the patient’s ventilator waveform showed significant inspiratory effort, triggering the flow adaptation feature and switching the ventilator from volume control with constant flow to pressure control with variable flow. This dual targeting mode, called Volume Control with Flow adaptation, resulted in twice the tidal volume delivered to the patient and increased the risk of volumotrauma. The flow adaptation was subsequently turned off, and the sedation was adjusted to prioritize lung protection for the patient. This case highlights the importance of monitoring patient-ventilator interaction and choosing appropriate ventilator settings to prevent lung injury in patients with ARDS. Keywords ARDS, IMV, Volumotrauma, Flow adaptation